EP1326538A1 - Procede et appareil de cartographie efficace du champ visuel a haute resolution - Google Patents

Procede et appareil de cartographie efficace du champ visuel a haute resolution

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Publication number
EP1326538A1
EP1326538A1 EP01979632A EP01979632A EP1326538A1 EP 1326538 A1 EP1326538 A1 EP 1326538A1 EP 01979632 A EP01979632 A EP 01979632A EP 01979632 A EP01979632 A EP 01979632A EP 1326538 A1 EP1326538 A1 EP 1326538A1
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EP
European Patent Office
Prior art keywords
patient
fixation
computer
retinal
test
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP01979632A
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German (de)
English (en)
Other versions
EP1326538A4 (fr
Inventor
Dror Zur
S. c/o The Weismann Institute for Science ULLMAN
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Yeda Research and Development Co Ltd
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Yeda Research and Development Co Ltd
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Publication date
Application filed by Yeda Research and Development Co Ltd filed Critical Yeda Research and Development Co Ltd
Priority to EP06024878A priority Critical patent/EP1767155A1/fr
Publication of EP1326538A1 publication Critical patent/EP1326538A1/fr
Publication of EP1326538A4 publication Critical patent/EP1326538A4/fr
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/02—Subjective types, i.e. testing apparatus requiring the active assistance of the patient
    • A61B3/024—Subjective types, i.e. testing apparatus requiring the active assistance of the patient for determining the visual field, e.g. perimeter types
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/02—Subjective types, i.e. testing apparatus requiring the active assistance of the patient
    • A61B3/028—Subjective types, i.e. testing apparatus requiring the active assistance of the patient for testing visual acuity; for determination of refraction, e.g. phoropters
    • A61B3/032—Devices for presenting test symbols or characters, e.g. test chart projectors

Definitions

  • the present invention relates to an apparatus and method for high-resolution, low-cost perimetry, and more particularly, relates to an apparatus and method for high-resolution, low-cost perimetry for improved the static and kinetic visual filed mapping.
  • Visual field mapping (fundus perimetry) is a psychophysical test performed by projecting small light stimuli to different locations and different perimeters of the fundus. It is commonly used in the detection, diagnosis and evaluation of several retinal, optic nerve and brain diseases, such as glaucoma, retinitis pigmentosa and stroke.
  • the most commonly used apparatus are the photopic Goldman device which uses a manual kinetic test, 1 and the photopic and scotopic Humphrey instrument which uses an automatic static test. 2"5
  • a dot of light is flashed at random locations onto a visual field and the patient signals when he/she sees the flash. The patient adjusts fixation between each flash by a centrally presented target. This method allows for both screening and threshold mapping.
  • a dot of light moves in straight lines in the visual field, and the patient signals when the dot is visible and when it disappears.
  • the patient is required to maintain fixation.
  • the kinetic test is considered rapid but imprecise, 1,6,7 and it is usually used for qualitative tests, such as depicting lines of equal sensitivity in the visual field.
  • the conventional apparatuses described above are not suitable for mapping inside the macula region, since an accurate high-resolution mapping is required.
  • the Goldman perimeter is limited by the problem posed by the patient's response delay and the fact that operator monitoring is done manually', while the Humphrey instrument has limitations imposed by its software implementation (the most common mapping resolution is 4°) and the resolution of the bulbs in its hemisphere.
  • the patient's eye movements can cause significant errors at high- resolution of less than 1°.
  • the new generation of fundus perimeters enables the visualization of the retina with precise high-resolution mapping superimposed on it.
  • the most sophisticated of them is the scanning laser ophthalmoscope (SLO). 6,7 ' 9 ' 12"22
  • SLO uses two simultaneous laser beams, an invisible infrared beam for imaging the retina, and a visible red beam for perimetry.
  • the SLO enables automatic kinetic and static studies with a resolution of 2 minutes of arc (0.033°). The operator can see the retinal image and the fixation target during the test, and can thus compensate online for significant eye movements.
  • the SLO and other advanced fundus perimeters are attractive for research, but they are still not in widespread practical use, mainly due to their high cost and cumbersome operation.
  • the present invention seeks to overcome the disadvantages and drawbacks of the prior art, as explained above, and provides a method and apparatus for high- resolution, low-cost perimetry, and more particularly, relates to an apparatus and method for high-resolution, low-cost perimetry for improved the static and kinetic visual filed mapping.
  • the focus of the work leading to the present invention concerned mapping macular scotomas and checking the residual sight in them, by using common affordable tools.
  • the main goal was to achieve low-cost high- resolution mapping with minimal eye movements error, and with results that can be automatically visualized on the fundus photograph.
  • the foregoing is accomplished by the present invention by employing as the perimeter a portable computer and a projector, and using two screening methods, multi-resolution static and bi-directional kinetic.
  • the invention as applied to a static test starts with relatively low-resolutions, and only the unseen zones are selectively remapped under higher resolutions during successive iterations.
  • the invention as applied to a kinetic test uses a response to a continuously moving target, and the unknown response delay is compensated for by an algorithm that merges the patient's response to measurements at the same visual location, but with opposite scanning directions. Offline visualization of the mapping results is performed automatically superimposed over the fundus image.
  • Figure 1A is a schematic illustration showing the perimeter.
  • Figure 1 B is a representation showing a subject fixated on the screen of the perimeter of Figure 1A.
  • Figures 2A and 2B are schematic representations illustrating two successive iterations of the multi-resolution static technique of the present invention.
  • Figure 3 is a schematic illustration showing how the present invention solves the response delay of the kinetic visual field mapping.
  • Figures 4A, 4B and 4C are schematic representations showing an example of a horizontal kinetic test over the blind spot of an intact retina with Figure 4A showing a subject's raw data for left-to-right scans, Figure 4B showing the subject's raw data for right-to-left scans and Figure 4C showing the output of the merging algorithm of the present invention.
  • Figures 5A and 5B are schematic visualizations of the static and kinetic mapping, according to the present invention, over the blind spot of an intact retina of a patient.
  • Figures 6A and 6B are schematic visualizations of the static and kinetic mapping, according to the present invention, over the damaged macula of a patient.
  • Figure 7 is graphical representation of the percents of inconsistent point and average of inconsistency error versus visual acuity.
  • the present invention presents a method and apparatus to obtain a high- resolution low-cost perimeter, and in this detailed description of preferred embodiments describes improvements offered by two modes of operation, the static and kinetic visual filed mapping.
  • the perimeter which may be used, it may consist of a portable computer and a projector, that may be operated using two screening methods, multi-resolution static and bi-directional kinetic.
  • the static method the static test starts with relatively low-resolutions, and only the unseen zones are selectively remapped under higher resolutions during successive iterations.
  • the kinetic method uses a response to a continuously moving target, and the unknown response delay is compensated for by an algorithm that merges the patient's response to measurements at the same visual location but with opposite scanning directions. Offline visualization of the mapping results is performed automatically superimposed over the fundus image.
  • the main features of the present invention include rapid, accurate, and repeatable high-resolution visual field mapping (micro-perimetry) by using multi-resolution static mapping, bi-directional kinetic mapping or high- sensitivity bi-directional kinetic mapping.
  • the inventive multi-resolution static mapping method includes the steps of flashing a dot of light at random locations in the tested visual field, fixation adjustment between each flash using a centrally presented target, detecting whether or not the patient sees the flash, by the patient signaling "see” or "not see”. Essentially, the dot of light that is flashed is stepped from point to point, but not necessarily in order, but rather in random fashion.
  • the method starts with relatively low-resolutions in a first phase, in order to rapidly obtain indications of the unseen regions, and with successive iterations remaps only the unseen regions under higher resolutions.
  • the final results are presented with uniform resolution (see Figure 2). Therefore, the highest tested resolution (regions which were tested merely with lower resolution are decomposed to the highest resolution, with the decomposed values being identical to the original value).
  • a screening and threshold mapping can take place. In screening, only one intensity is used whereas in threshold mode, the intensity is varied from a low value to a high value to discover the threshold between "see” and "not see” for the intensity range. In the threshold mapping, the iterations are repeated for each tested intensity.
  • the bi-directional kinetic mapping method of the present invention includes the steps of moving a dot of light in lines at the tested visual field, maintaining patient fixation during each line scan, detecting patient signals when the dot becomes visible or disappears, computing the patient's response delay by merging the patient's response to scans at the same visual location but with opposite scanning directions (each tested visual location is scanned with two opposite directions), determining the actual location of the patient's signal at a point between each two corresponding opposite signals (see Figure 3). There are two types of presentation for the results d.
  • topographic lines are derived showing the connecting lines of neighboring points of the same level of perceptual vision transition.
  • discretization is usually in the form of a rectilinear display (see Figure 4).
  • the topographic lines usually in the form of polar display, produces a map of the transition between "see” and “not see” signals.
  • the bi-directional kinetic mapping according to the invention includes screening and threshold mapping.
  • the screening takes place using one selected intensity whereas for the threshold mapping, the scans are repeated for each tested intensity. Segments or points, which were unseen in higher intensity, or seen in lower intensity, are skipped. Acceleration is achieved by first testing with the lowest and highest intensities, and then testing with the intermediate intensities.
  • Another feature of the present invention is the inclusion in the method and apparatus of a correction of the influence of eccentric fixation under central disorder. This is accomplished by finding, in advance, the eccentric fixation retinal point (for example by using slit-lamp and red laser beam, according to known technology), computing, in advance, the distance and orientation of the eccentric fixation point from the normal fixation point (the center of fovea), and displacing each tested location in the visual field by the computed distance and orientation.
  • the methods of the invention utilize offline visualization of the mapping results over the retinal photograph using the computer-microprocessor by finding, in advance, the fixation retinal point (for example by using slit-lamp and red laser beam), scanning, in advance, the retinal photograph, into the computer, including its scale, signing the ⁇ fixation point on the retinal computer image, offline graphical drawing of the test result over the retinal image, aligning it with the fixation point (the orientation is assumed to be fixed for all the subjects, since the patient's head is stabilized). See Figure 5 and 6 for the visualization of the static and kinetic results.
  • a high-resolution fundus perimeter was constructed using a laptop computer and a projector constituting a portable perimeter.
  • the scheme of the overall arrangement of the perimeter is shown in Figurel A, and an example of a patient fixating on the screen is shown in Figure 1 B.
  • the main components of the perimeter are a laptop computer 10, a Liquid Crystal Diode (LCD) projector 12, and a fiberglass screen 14 on which appears a cross encompassed by a circle.
  • the laptop is connected to the projector via a Red Green Blue (RGB) connection.
  • Figure 1(B) shows a subject 20 fixating on the screen 14.
  • the subject's head is stabilized to eliminate involuntary movements.
  • the cross surrounded by the circle projected onto or otherwise imposed on the screen 14 is the fixation target.
  • the patient's head is stabilized in order to eliminate involuntary movements, and the operator is using the laptop to control the test procedure.
  • an IBM ThinkPad 600E laptop with an Intel Pentium-ll MMX 300MHz processor and 128MByte memory was used.
  • the projector was a NEC MT810G with a 600 ANSI lumens maximum light intensity, a more than 200:1 contrast ratio, and 800*600 dots resolution.
  • the projector was located 83 cm horizontally from the screen, and displayed a picture that is 40 cm diagonally. With this arrangement, the luminance of the entire image remains uniform with little loss in intensity.
  • the patient was seated close to the screen (about 20 cm) in order to retain the high and uniform brightness.
  • the maximum visual field resolution that can be achieved under this setting is 0.12 minutes of arc (0.002°).
  • the perimeter can translate any desired visual field location to its corresponding pixels of the picture on the screen 14.
  • the perimeter takes into account the eccentric fixation of the patient and the derived blind spot location.
  • the patient was asked to adjust fixation on a cross, surrounded by circle ( Figure 1 B), The circle, a feature of the present invention, was added to help patients with central scotoma who see a cross only faintly.
  • two high-resolution mapping methods were developed, one static and one kinetic.
  • a dot of light is flashed in random order in the tested visual field region, and the patient uses a dual-state switch to signal whether or not the flash was visible. It was found that a 300 msec flash is long enough to be perceived by low vision patients, yet short enough to eliminate significant eye movements of a watchful patient. 11 If the patient indicates that he did not see a specific flashed location, this location is flashed once again randomly later on. Only if the location was not seen in two attempts was it considered as being unseen. This method of the invention needs a relatively large number of flashes to cover the macular region.
  • Figures 2A and 2B show an example of the result of two successive iterations of the multi-resolution static technique. The relevant statistics are presented below each iteration.
  • Figure 2A shows the first iteration, which consisted in mapping a circle of 12° radius and of 2° resolution.
  • the 'X' denotes an unseen dot and the 'O' denotes a seen dot.
  • Figure 2B shows the second iteration, which consisted in mapping under double resolution only the dots which were unseen in the first iteration. The dots which had been seen in the first iteration are denoted by 'o'.
  • the scanning can be effected by actually moving the light beam projected onto the screen, or by successively lighting adjacent areas or pixels of the screen. That is the successive lighting creates an apparent movement of the light.
  • the two upper lines having opposite moving directions, but represent the same visual field location.
  • the displacements between the patient's signals in the left-to-right line and the corresponding signals in the right-to-left line are estimated as twice (*2) the response delay.
  • the actual locations are determined halfway between each two corresponding signals as represented by the bottom third line.
  • the displacements between the patient's signals in the left-to-right motion and the corresponding signals in the right-to-left motion are estimated as caused by twice the response delay, and the actual transition locations are determined at the halfway point between the two corresponding signals.
  • An algorithm was developed to enable the merging of corresponding opposite signals and to eliminate spurious signals. It was found that a scanning rate of 1.5 °/sec to be optimal for low vision patients.
  • the lines and/or points of the visual field are scanned in random order. During each scan, the patient is asked to maintain a steady fixation.
  • Figures 4A, 4B and 4C show an example of the result of the test over the blind spot of an intact retina. What is portrayed in these Figures is an example of the result of a horizontal kinetic test over the blind spot of an intact retina.
  • Figure 4A shows the subject's raw data for the left-to-right scans. 'O' denotes the signal where the patient started seeing, and the 'X' denotes the signal where the patient stopped seeing.
  • Figure 4B shows the subject's raw data for the right- to-left scans with the same notation as in Figure 4A.
  • Figure 4C shows the output of the merging algorithm. The 'X' denotes unseen points and the 'O' denotes seen points.
  • FIG. 4B present the subject's raw data for the left-to-right scans and the right-to-left scans, respectively.
  • Figure 4C shows the output of the merging algorithm.
  • the horizontal resolution is defined only for presentation purposes since the scans are perceived continuously due to the apparent motion effect. 23
  • a "seen point” in the kinetic test is a point that fell within a seen segment of the merged line, and in the static test, is a point that was seen at least once.
  • an "unseen point” in the kinetic test is defined as a point that fell in or occurs in an unseen segment of the merged line, and in the static test, as a point that was not seen after two attempts.
  • reference is made only to the map of the final phase. Using these definitions, one can define an "unseen region” as a region in which most of the points are unseen, and a “seen region” as region in which most of the points are seen. The border between these two kinds of regions is defined as the "mapping-border".
  • the seen points in the unseen region and the unseen points in the seen region are defined as "inconsistent points”.
  • Visualization of the results over the fundus image is performed offline for both techniques.
  • the retinal fixation point is indicated, for example by using a slit lamp with a narrow red beam, according to known technology.
  • the operator should just insert the scale of the fundus image and identify the fixation point in it, and then, the mapping result is instantly visualized over the image.
  • Perimeter was tested in a primary study that extended over a period of one year on eight subjects, four healthy of both sexes with intact retinas as a control, and four males with damaged retinas associated with AMD.
  • Figures 5A and 5B show an example of the visualization of the static mapping, Figure 5A, and kinetic mapping, Figure 5B, over the blind spot of the intact retina of subject #1.
  • the mapping-border is congruent with the blind spot in both mapping methods.
  • some inconsistent points are observable inside the blind spot region in the static mapping, while all the points are consistent in the kinetic mapping.
  • the congruency of the mapping-border and the apparent border of the corresponding spot in the fundus image on the one hand, and the inconsistency of the static method on the other hand, are even more salient when mapping damaged retinas.
  • Figure 6 shows representative results of the static, Figure 6A, and the kinetic, Figure 6B, tests for the damaged macular region of patient #5.
  • the incongruent region size is less than 0.6 Disk Area (DA) while the scotoma size is 22 DA (less than 3% of incongruency) - and there is no inconsistency.
  • the static test reveals poorer correspondence (7% of incongruency) with significant inconsistency at the center of the unseen region. Since repeatable static tests over the same region resulted in different inconsistent points inside the unseen region, a probable assumption one can make is that these inconsistent points occurred by random eye movements of the patient.
  • the error of an inconsistent point was computed as the distance of the point from its closest border point.
  • the reason for measuring this distance is that an inconsistent point at distance d from its region border can be caused by eye movements of size d or larger.
  • the average inconsistency error of a test is the average of the error of its inconsistent points. This computation takes into account merely the displacement of an inconsistent point from its closest border point, and not from its original location which is unknown. It also does not take into consideration eye movements that displace the test points but leaves them in their original seen or unseen region. However, it is believed that this measure indicates the tendency of the eye movements error, with some unavoidable variance.
  • Figure 7 shows the inconsistency level of the two methods, and the relation between the inconsistency and visual acuity.
  • the graph in Figure 7A demonstrates that the static method is less consistent than the kinetic method, since for each visual acuity, the static method has more inconsistent points.
  • Applying a non- parametric Wilcoxon test, which assumes no prior knowledge of the distribution, yields a border significant difference between the static and the kinetic (p 0.0612).
  • the multi-resolution static test converges toward the unseen sub-regions, accelerating the duration of the standard static test.
  • the total test duration was divided by the number of points that would be generated in the initial visual field region under the final resolution (which is the same as the initial resolution in fixed-resolution test).
  • the average time per point in the common static test is 14.1 seconds compared with 3.6 seconds for the multi-resolution test, a saving of 75% in test duration.
  • the kinetic test does not change with resolution, but its speed arises from its continuous mapping.
  • the duration of the kinetic test was divided by the number of points that would be generated by the static test over the same region and with the same final resolution. The average result of 25 tests was 2.6 seconds per point. It implies that most of the static test time is consumed by the fixation adjustment between the flashes. In addition, most of the subjects reported that the static test was more tedious. However, the kinetic test requires some training trials until the patient can maintain the fixation while the testing point is moving. In contrast, the patient can start the static test almost immediately and adjust fixation between the flashes.
  • Residual vision is expected to be found as repeatable seen points in the unseen region, namely as inconsistent points in the unseen region that arise consistently in the same visual field location. However, it will be necessary to use more sensitive tests to explore the presence of residual vision. In the kinetic test, residual vision may also be revealed by blurred points.
  • the present invention provides a low-cost high-resolution perimeter with the ability to visualize the results over the fundus photograph.
  • the low-cost implementation was accomplished by using off-the-shelf standard computer and projector equipment.
  • the test In order to achieve the high-resolution requirement, the test must be accurate and sufficiently short.
  • the high-resolution mapping was implemented by using two different methods. The first method is static in nature and, therefore, requires adjustment between each flash. The duration of this commonly used test was reduced by implementing a multi-resolution procedure. Although the test was considerably shortened, it does not avoid the tedious fixation effort required from the patient throughout such test. This continuing effort results in eye movements and inconsistent points which become more significant as the visual acuity of the patient decreases.
  • the invention implemented a second method, bi-directional kinetic. It was necessary to overcome the problem of unknown response delay by developing an appropriate merging algorithm.
  • the kinetic test results better fit the scotomas in fundus photographs, were more consistent, and therefore, more repeatable, and usually shorter than the static test.
  • the kinetic test required some training before the subject, especially the elderly, can maintain fixation and achieve consistent results.
  • the present inventive method and apparatus are considerably less expensive, and can provide results that in practice approach those of the SLO.
  • the most salient difference between the two apparatuses is their visualization technique.
  • the visualization is done online, enabling detection and correction of eye movements.
  • the techniques developed according to the present invention enable rapid static mapping and accurate kinetic mapping, which minimize the influence of eye movements on the consistency of the results.
  • the SLO visualization is done over laser imaging, which is less familiar in the community, and raises difficulties in detecting atrophies, edemas and other types of retinal damage.
  • the present invention visualization has an advantage since it can be presented over different types of images, such as fundus photographs or angiography images.
  • the inventive methods include a multi-resolution static method and a bi-directional kinetic method, for performing rapidly high- resolution accurate and repeatable visual field mapping
  • the inventive apparatus includes a low-cost system for the purpose of carrying out the inventive methods.
  • the invention can be used to detect and to follow the evolution of visual disorders caused by injury, stroke, disease, or other cause, from the first stages to the advanced levels, by screening or mapping the sensitivity, of any region in the visual field.
  • the present invention overcomes the long duration problem of an accurate static test, and the accuracy problem of a rapid kinetic test, enabling rapid and accurate mapping by both types of tests.
  • the time-efficiency of the disclosed inventive methods facilitates the fixation effort of the tested subject, and reduces the crucial influence of the eye movement error.
  • the blur perception which appears in the kinetic test, enables the performance of a high-sensitivity threshold test.
  • the methods of the invention enhance the fixation ability by using centralized peripheral fixation target, and take into account eccentric fixation by translating appropriately the tested region.
  • the methods can be performed using the inventive apparatus comprising a small display screen, such as, a laptop computer, or with interactive local displays connected via a telemetric connection, like the Internet.
  • the detection and correction of the eye movement is improved, by online tracking the subject pupil using a digital camera and tracking algorithm at the local site in accordance with known technology. Offline visualization of the mapping results is performed using known technology by automatically superimposing over the retinal photograph.
  • the main features of the present invention include rapid, accurate, and repeatable high-resolution visual field mapping (micro-perimetry) by using multi- resolution static mapping, bi-directional kinetic mapping or high-sensitivity bidirectional kinetic mapping.
  • the inventive multi-resolution static mapping method includes the steps of flashing a dot of light at random locations in the tested visual field, fixation adjustment between each flash using a centrally presented target, detecting whether or not the patient sees the flash, by the patient signaling "see” or "not see”. Essentially, the dot of light that is flashed is stepped from point to point, but not necessarily in order, but rather in random fashion.
  • the method starts with relatively low-resolutions in a first phase, in order to rapidly obtain indications of the unseen regions, and with successive iterations remaps only the unseen regions under higher resolutions.
  • the final results are presented with uniform resolution. Therefore, the highest tested resolution (regions which were tested merely with lower resolution are decomposed to the highest resolution, with the decomposed values being identical to the original value).
  • screening and threshold mapping takes place. In screening, only one intensity is used whereas in threshold mode, the intensity is varied from a low value to a high value to discover the threshold between "see” and "not see” for the intensity range. In the threshold mapping, the iterations are repeated for each tested intensity. Regions, which were unseen at higher intensity, or seen at lower intensity, are skipped. Acceleration is achieved by first testing with the lowest and highest intensities, and then testing with the intermediate intensities.
  • the bi-directional kinetic mapping method of the present invention includes the steps of moving a dot of light in lines at the tested visual field, maintaining patient fixation during each line scan, detecting Patient signals when the dot becomes visible or disappears, computing the patient's response delay by merging the patient's response to scans at the same visual location but with opposite scanning directions (each tested visual location is scanned with two opposite directions), determining the actual location of the patient's signal at a point between each two corresponding opposite signals (usually the halfway point).
  • presentation There are two types of presentation for the results obtained. In one form of presentation, "topographic lines" are derived showing the connecting lines of neighboring points of the obtained perceptual vision transition.
  • the actual points with their perception values are presented.
  • the movement of the dot of light and the mapping may be either rectilinear or polar (radial).
  • the discretization presentation is usually in the form of a rectilinear display.
  • the topographic lines produces a map of the transition between "see” and “not see” signals.
  • the bi-directional kinetic mapping according to the invention proceeds with screening and threshold mapping. The screening takes place using one selected intensity whereas for the threshold mapping, the scans are repeated for each tested intensity. Segments or points, which were unseen in higher intensity, or seen in lower intensity, are skipped. Acceleration is achieved by first testing with the lowest and highest intensities, and then testing with the intermediate intensities.
  • the high-sensitivity bi-directional kinetic mapping method comprises the step further steps of using three states of subject response, namely, "seen”, “unseen”, and “seen blurly", the last- mentioned response being between the first two, as explained in the foregoing.
  • two thresholds are attached to each tested region, one being the transition from “unseen” to “seen blurly”, and the other being the transition from "seen blurly” to seen .
  • Another feature of the present invention is the inclusion in the method and apparatus of a correction of the influence of eccentric fixation under central disorder. This is accomplished by finding, in advance, the eccentric fixation retinal point (for example by using slit-lamp and red laser beam, according to known technology), computing, in advance, the distance and orientation of the eccentric fixation point from the normal fixation point (the center of fovea), and displacing each tested location in the visual field by the computed distance and orientation.
  • the patient's fixation ability under central disorder can be sustantially enhanced and sustained using a centralized circle (or another centralized geometric
  • the invention presents a circle (or another geometric (polygon) pattern - unbroken preferred, but may be broken) whose perimeter is located at the peripheral visual field and whose center is located at the center of the visual field (the fixation point).
  • the patient is asked to fixate on the center of the circle (unseen point) which is well estimated according to the periphery (the seen points).
  • online detection and correction of the influence of eye movements is effected by using a digital camera to watch the subject's eyes, with online tracking (using a computer including a microprocessor) of the pupils in the sequence of the eye's images to estimate the viewing direction of the subject relative to the desired fixation point.
  • the output signals are fed to the computer-microprocessor to effect online displacement of the tested location in the visual field, according to the relative distance and orientation between the actual fixation point and the desired fixation point.
  • the methods of the invention utilize offline visualization of the mapping results over the retinal photograph using the computer-microprocessor by finding, in advance, the fixation retinal point (for example by using slit-lamp and red laser beam), scanning, in advance, the retinal photograph, into the computer, including its scale, signing the fixation point on the retinal computer image, offline graphical drawing of the test result over the retinal image, aligning it with the fixation point (the orientation is assumed to be fixed for all the subjects, since the patient's head is stabilized).
  • the fixation retinal point for example by using slit-lamp and red laser beam
  • the invention provides display of the high-resolution test on a small screen by entering in a computer or microprocessor (which may include the display screen) in advance the measures (diagonal, or vertical and horizontal size) of the small display screen (for example, the laptop screen, or the image projected on a viewing screen), entering into the computer in advance the distance of the subject from the screen, calculating via the computer (offline or online), for each desired visual field location, the corresponding region on the screen, and online providing a Presentation of each visual field location at the appropriate region on the screen.
  • a computer or microprocessor which may include the display screen
  • the measures for example, the laptop screen, or the image projected on a viewing screen
  • the method is carried out by the steps of separating the software to client and server modules, installing the client module software at a local computer where the patient will be tested, programming the client module software to be responsible for the display, and the interface with a subject patient, programming the client module software to use the local small screen for the display, programming the server module software to be responsible for the test planning, test management, and for storing and analyzing the results of multiple tests according to the methods of the invention as described in the foregoing, and programming the server to connect via the telemetric connection with multiple clients, and interconnecting the server with multiple clients via a telemetric connection, preferably the Internet.
  • the invention also contemplates the online detection and correction of the eye movements of a patient undergoing test via a telemetric connection like the Internet by the steps of programming the client module software to use a local digital camera with which it is connected, and programming the client module software to be responsible for the online pupil tracking algorithm, and for the online detection and correction of the eye movements.
  • offline visualization via a telemetric connection like the Internet can be accomplished by the steps of scanning the retinal photograph of a patient at the local site to obtain a retinal image, sending the retinal image and its relevant data to the server for storing, and sending the retinal image to the local site upon request for visualization.
  • the invention provides high-resolution, accurate, repeatable and sensitive detection, follow-up and future estimation of the evolution of visual disorders, central or peripheral, with small (less than 1°) and big (couple of degrees) damaged regions, caused by injury, stroke, disease, or other cause, from the first stages to the advanced levels, by using the novel multi-resolution static mapping method, the novel bi-directional kinetic mapping method or the novel high-sensitivity bi-directional kinetic mapping method, or any combination of the above methods in any sequence.
  • the novel micro-perimeter apparatus of the present invention comprises the components described to effect multi-resolution static mapping, bi-directional kinetic mapping, high-sensitivity bi-directional kinetic mapping, correction of the influence of eccentric fixation under central disorder, presentation of a centralized circle (or another centralized geometric pattern) to enhance the fixation ability under central disorder, online detection and correction of the influence of eye movements, offline visualization of the mapping results over the retinal photograph, display of the high- resolution test on a small screen, interactive local displays connected via telemetric connection, online detection and correction of the eye movements via telemetric connection and offline visualization via telemetric connection.
  • the apparatus utilizes computers including the usual input/output, memory and microprocessor, as well as servers and communication connections, as necessary, to transmit information from one point to another, as duly noted above.
  • computers including the usual input/output, memory and microprocessor, as well as servers and communication connections, as necessary, to transmit information from one point to another, as duly noted above.
  • the programming of computers and communication gear from the description above would be readily apparent to one skilled in the art to implement the described functions.

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Abstract

L'invention concerne une technique de micropérimètre utilisant un ordinateur portable (10) ainsi qu'un projecteur (12), et utilisant deux procédés de projection sur écran (14) à multirésolution statique et cinétique bidirectionnelle. Le procédé statique, tel qu'appliqué à un test statique, débute avec des résolutions relativement faibles, et uniquement les zones non vues sont recartographiées sélectivement sous des résolutions plus élevées au cours d'itérations successives. Le procédé cinétique bidirectionnel, tel qu'appliqué à un test cinétique, utilise une réponse à une cible en mouvement continu, et le retard de réponse inconnu est compensé par un algorithme faisant fusionner la réponse du patient à des mesures effectuées sur le même emplacement visuel, mais avec des directions de balayage opposées. Les visualisations hors ligne des résultats de cartographie sont effectuées automatiquement en superposition sur l'image du fond.
EP01979632A 2000-10-11 2001-10-09 Procede et appareil de cartographie efficace du champ visuel a haute resolution Withdrawn EP1326538A4 (fr)

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EP06024878A EP1767155A1 (fr) 2000-10-11 2001-10-09 Procédé cinétique pour le mappage à haute résolution du champ visuel

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US686604 2000-10-11
US09/686,604 US6406437B1 (en) 2000-10-11 2000-10-11 Method and apparatus for efficient high-resolution visual field mapping
PCT/US2001/031582 WO2002030291A1 (fr) 2000-10-11 2001-10-09 Procede et appareil de cartographie efficace du champ visuel a haute resolution

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EP06024878A Withdrawn EP1767155A1 (fr) 2000-10-11 2001-10-09 Procédé cinétique pour le mappage à haute résolution du champ visuel

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EP (2) EP1326538A4 (fr)
AU (1) AU2002211569A1 (fr)
CA (1) CA2425177A1 (fr)
IL (1) IL155166A0 (fr)
WO (1) WO2002030291A1 (fr)

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IL155166A0 (en) 2003-10-31
CA2425177A1 (fr) 2002-04-18
AU2002211569A1 (en) 2002-04-22
EP1767155A1 (fr) 2007-03-28
EP1326538A4 (fr) 2006-02-08
WO2002030291A1 (fr) 2002-04-18
US6406437B1 (en) 2002-06-18

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